ArthroCare ENT USSymptom Discussion Guide for a Coblation Tonsillectomy
Print this form and fill it to take it with you when you visit your child’s doctor.
Child’s Name: _____________________________________________
Date of Birth: ________/_________/_________
Age:__________
Sex: M / F
Check off any symptoms that your child has below.
| ____ | Loud and/or labored breathing |
| ____ | Severe difficulty swallowing |
| ____ | Frequent and disruptive gasping or snorting noises |
| ____ | 3-4 episodes of infectious tonsillitis per year for 3 years in a row |
| ____ | 5 episodes of infectious tonsillitis in one year |
| ____ | 7 episodes of infectious tonsillitis in two years |
| If your child is younger than 5, | |
| ____ | Gasping for air while sleeping |
| ____ | Breathing stops while sleeping |
| ____ | Breathing through the mouth while sleeping |
| ____ | Regularly waking up in the middle of the night |
| ____ | Restlessness |
| ____ | Snoring |
| If your child is older than 5, | |
| ____ | Bed wetting at night |
| ____ | Behavior problems |
| ____ | Shortened attention span |
| ____ | Underweight, overweight, or experiencing abnormal appetite for his/her age |
| ____ | Snoring |
Find a surgeon in your area.
If your child needs his or her tonsils removed, you’ll probably need to see an otolaryngologist or ENT (Ear, Nose, and Throat) surgeon. Ask your pediatrician about the surgeons who perform Coblation® tonsillectomy in your area, or visit www.tonsilfacts.org, and write down their names here:
| Physician Name | Medical Group/Hospital | Address & Telephone |